In Loving Memory

I hesitated to write about this lady. But she was wonderful--and her story, what little I know of it, deserves to be made known. Her name was Mariama, she had a gorgeous smile and loved others. One day, about a month ago now, Carrie and I were walking back to our housing compound from spending some time in the Lunsar market (buying some vegetables, cloth, and cooked eggs), when we heard our names being called. We looked to the left and saw our friend Mariama, one of our national workers, sitting on the porch. She invited us over and introduced us to her small children who were busy playing with their cousins. The one was about six years old and the other about six months old. We talked to Mariama for a little while then continued on our walk.

The same day I began to get sick, Mariama was also sick. Her story and mine are similiar yet have drastically different outcomes. We both started to feel ill and we reported it. We both sought treatment. Right now, in Sierra Leone, we initially test you for malaria and Ebola. Mariama and I tested negative for both. But Mariama continued to worsen...and we began to suspect something else, something almost as sinister as Ebola and far more common to West Africa. Mariama was tested for Lassa Fever, which is a hemorrhagic (bleeding) fever that is often fatal. The difference between it and Ebola, however, is there is a drug we can use to treat it--as long as it is caught in time and you are in a place where the drug is on hand. We sent Mariama to Kenema, one of the few places in the country that currently has the capability to treat Lassa Fever. She responded to treatment and began to improve. But then Sunday, two days after I was released from Kerrytown, we received the news you never want to hear. Although Mariama had initially shown signs of improvement; she was gone. Her six-year-old and six-month-old had lost their mother. Is their father in the picture? I don't know. It isn't atypical for the father to be completely absent. Carrie and I did not meet him the day we met Mariama's sweet children.

Pray for those tiny babes, friends. Pray for the children who are losing their parents to Ebola and Lassa Fever. There are so many more orphans now in West Africa. Please, do not forget them.

"Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress and to keep oneself from being polluted by the world." James 1:27

Photo Friday (part 2)

 Beachfront of Freetown

A shantytown in Freetown--devastated recently by a cholera outbreak :-(

 Bureh Beach

View from Bureh Beach

Our ETC around Dusk

Photo Friday has Returned! (part 1)

 A view of our recently completed training center in Lunsar

 The "Mock ETC" at the Training Center

 Overlooking Freetown

 A Creole house

 "Minister" birds. Aka owner of the most obnoxious 

windpipes at 0600. I do not miss this bird at all!

There are billboards all over that speak 

about Ebola, many say "Ebola is real."

Sierra Leoneans can carry practically anything on their heads! They have incredible posture!

 Celebrating Valentine's Day in Sierra Leone (Med tent)

 Narrow bridge...that apparently is "beyond" its lifespan. I was happier when I was blissfully unaware that my life may be on the line each time we transversed this bridge...

Ebola Graffiti in Freetown

Hard to read because Dr. Jean and I saw this sign out of the corner of our vision and just barely snapped the photo in time! Reads: "Respect Ebola Survivors & Health Workers/They are our Heroes"

Returned to Work :-D

Sunday, the day I was supposed to be leaving Sierra Leone, I was given permission to leave housing. Did I leave? No! But just the knowledge that I now had the permission, the ability, the freedom to leave, was quite comforting. Makes me think of the elderly in the US that have their driver's licenses taken from them...and for those around the world who do not have the freedoms that I take for granted each and every day.

Monday I was allowed to work! I chose to work nightshift, as a nightshift would have been the last shift I was originally supposed to work before leaving Sierra Leone. I cannot describe how wonderful it felt to walk back toward the ETC, how nice it was to lift one foot then the other to have the sole of the shoe sprayed with the chlorine and to put the "gumboots" back on. I had thought that I wouldn't be allowed back at work before leaving Sierra Leone, and that had made me quite sad. It was wonderful to see the national staff: "Where have you been? Are you better? We thought you left without saying goodbye." It was wonderful to be doing what I came to Sierra Leone to do--fight Ebola alongside my teammates.

There was only one patient in the ward that was the same since I had last worked. All the rest had gone--some discharged, and unfortunately, some had died.

We had 14 patients again. The last day I worked there had only been 6. Seems the roller coaster is going to continue for awhile.

Our current 'outbreak' of patients that are testing Ebola-positive and subsequently dying are from one family. We believe the current influx of positive patients stem from one individual--a cured patient who had sexual relations and gave the other person involved Ebola,  which then spread to the individual's family which includes a 4-yr-old and a 16-yr-old. Ebola virus lingers in some body fluids, semen in particular, for up to three months. We have heard that there is at least one individual in Sierra Leone who tells women that "he has the antibodies for Ebola and if the woman agrees to sleep with him, she will be safe." No. She won't be safe. She will most likely contract Ebola and more than likely die.

Survivors are given several things upon being discharged from an ETC. One of the things they are given is a large bag of rice. Before passing judgment on either the survivor or the person who as yet does not have Ebola--place yourself in his or her shoes. You have 2-5 small children. You can't find work, you haven't been able to work in months. Your youngest child looks to be on the threshold of death if you do not find food. What do you do?

It makes sense that a person who is starving, literally starving to death, would be willing to exchange his or her body for food. There isn't an easy fix for poverty.

But while there isn't an easy fix...we cannot ignore the problem either, that benefits no one.

An Insider's Perspective (partially) part 2

I took two showers a day while inside high risk just to break up the monotony of the day. Was semi-pointless though-I had to put the same shirt and pants back on each time! My pants I chose carefully before going to Kerrytown; one day a few weeks back I had been doused with chlorine from behind the knee down to my foot and well, the brown material was no match for chlorine! My pants were quite bleached. Ironically, that day I got doused with chlorine on my leg was the same morning I had thought, "My clothes haven't been damaged by the chlorine near as much as I expected they would be! Ah life and the irony...

Thursday I spent waiting for 3 pm to come around which would mean my blood would be drawn. Spent the morning working on french braiding my hair then the early afternoon I began to work on dutch braids as well. (Starting to think I should make a list of "Things to do while stuck inside high risk" when you have limited things at your disposal!! Thursday I also called home and heard some familiar voices which was quite encouraging to my spirits.

3:30 finally arrived!! Now to wait till 7 pm...which turned into 9 pm. At ten pm I left my tent and asked across the fence for my results. I was told "My results could not be radioed across the compound for patient privacy," which in part, I understand, patient privacy is important, however, let's face it, the WHOLE compound will soon enough know my result. If it is positive, I will be relocated to the confirmed ward; if negative, I will be discharged tomorrow. Privacy is important, I agree, however, there are some things that cannot actually be hidden...

I was then told, "We will send someone inside to chat with you about your result." And I panicked. Beyond a meltdown. I burst into tears, stumbled back into my tent towards my bed and grasped my phone. By this time in the evening most of my colleagues were asleep-morning comes early and work doesn't stop just because one person gets sick. I called the nurse who had told me she would remain awake until she heard my result--and explained to her what had just transpired and the turmoil I was currently in. She calmly reminded me that we rarely saw a patient test negative initially then test positive. She reminded me I was no sicker--and that my chief complaint continued to be my sore throat. "Is sore throat a symptom of Ebola?" "No, no it isn't, but medical people tell patients bad news face to face!!! I was negative yesterday and my result was exclaimed across the fence! What has changed? Except that now there are three of us inside suspect?" My friend continued to re-assure me and told me to call her back as soon as I knew. I tried to sleep, Ha! But I was too concerned and far too nauseous at this point to actually rest. At 10:30 or so a medical team entered my tent. I didn't recognize them, but after all, the only part of them I could see was their eyes. I was told I was negative! My heart burst with the words of the doxology and I called several co-workers and sent a text to family back home.

Such relief. Thank you, Jesus, thank you. Friday, Friday I would be reunited with my peers. Monday I will be back with my family. What a tremendous gift.

Friday morning transport was arranged and I spent some time talking to my fellow suspect patients, both sweet women who had also had one negative but were waiting for their second result to come back/second blood test to be taken. They celebrated with me as I walked out of suspect (after my chlorinated shower and all my clothes/things got burned or chlorinated) The nokia phone, well, sometimes it can beat the chlorine and sometimes it just can't. The SIM card survived but the phone itself did not. I tried soaking it in rice...but no dice.

I was picked up via ambulance after being discharged, now no longer having to ride in the back! I was dropped off outside my room and took a non-chlorinated shower and changed clothes. (even though I had been given new clothes...the jeans I had been given were a little snug! Which is surprising because I was told by more than one person I lost weight while inside Kerrytown even though it was only three days. The staff there had noticed as well--Thursday night they gave me "Plumpynut" which is something we give to someone who is malnourished as it is packed with protein!!)
After my wonderful hot water and fresh water shower, I was overwhelmed by loneliness. I had no way of contacting anyone as my phone had been destroyed by the chlorine. I wasn't allowed to go to work as I still had a sore throat. I went in search of my buddy who I worked every shift with up until the time I got sick--because as it was Friday, we were both supposed to work nightshift. I found her in her room and we talked about an hour after she got over the initial shock of seeing me. She then got a hold of the nurse who had been keeping my family informed and I got my cell phone back. Thankfully the wifi worked long enough for me to text family and tell them that I was okay but most likely would not be allowed to travel on Sunday. The US was talking about med-evacing (evacuating) me home even though I was Ebola negative because they weren't sure I should travel commercially and because I am a US citizen.

Let that sit on you. Here I am, across the world, 'suffering' from a common cold, a common respiratory infection. The US is contemplating flying me home by private small plane which would be quite costly...meanwhile, dozens upon dozens of West Africans are dying of a catastrophic disease.

You are blessed with where you were born, friend, never forget that. And please, remember the people, the men, women, and children who are dying of Ebola. Remember their families. Remember their loved ones. Pray for those who are utterly isolated.

It was decided that I could travel once I was symptom free for 48-72 hours, and so, regretfully, I was unable to come home Sunday as originally planned. While I wanted to see my family, I understood that I didn't want to give anyone else my cold. I was most bummed by the fact that, as I wasn't leaving Sunday, I would now be traveling alone. Sunday another doctor was leaving, and we actually had the same flights up until we would part ways in Dulles. We had both been looking forward to traveling back to US soil with a friend for weeks.

As I still had a sore throat Friday evening, I wasn't allowed to leave our housing compound. Appreciate your freedom, friends. I think we only appreciate freedom once we lose it--I know I do. Through this whole week my co-workers were abundantly supportive-from calls, visits, chocolates; one loaned me her computer that she had uploaded disney movies on it for me, she also visited me daily and provided me with more sudoku puzzles...

I experienced in part some of the stigma our survivors go through. I was allowed to re-enter the community, but only partially allowed back because I wasn't allowed at work initially. While no one was truly afraid of me, at times I had felt like I had done the wrong thing by following protocol and going to Kerrytown.

I am thankful for the insider's perspective I received, and I am so very grateful to God that I tested negative for Ebola. It is a terrible disease and continues to wreak havoc on the lives of many in West Africa.

An Insider's Perspective (partially) part 1

Hello all, I apologize for my silence for almost two weeks. Several of us discussed media Monday a week ago and I decided not to blog until I was safely stowed away in my quarantine house, which I now am.

Monday, February 16th, I woke up with a sore throat. Throughout the day I took my temperature and it was in the 99.0-99.6 range. I had intermittent headaches and was tired, but as I had been up 26 straight hours over the weekend followed by four hours good sleep then awake again for a training session, of course, being tired made perfect sense. My immune system had clearly taken a hit. Monday is my off day, so I remained in my room and relaxed (well, as much as you can relax when you are slightly under the weather and nervous that at any point your temperature will spike). I read, I blogged, a friend volunteered to come over which I turned down--if I am coming down with something, no need to share it! That afternoon my temp hit 100.2; not technically a fever yet but high enough that it warranted notifying my supervisor. I reported all my symptoms and a doctor and our head nurse came to my room that evening bringing dinner and donned in light PPE to assess me. They maintained the two meter wide berth as per protocol. The decision was made to re-evaluate me in the morning. Throughout the night I took my temperature each time I awoke. At 4 am it was 98.3! Hurray! I am fine! At 7 it was still in the 98 zone but, as I still had a sore throat, I was instructed to remain in my room and continue to hydrate and rest and try to recover. The headaches continued to come and go. In the afternoon my temperature began to climb again--but the power was out and it was most likely 85-90 degrees outside. Around dinner time a few friends came over to spend time with me on my porch (again, maintaining their distance out of precaution) and they were a welcome break to the monotony of my day. My temperature rose above 100 again; again to 100.2. The decision was made that evening for me to go to Kerrytown, the 'ex-pat etc' as it is nicknamed. It is really the healthcare worker ETC. It has several more capabilities then the ETC I work at--for one, Kerrytown has a lab on site and not only tests individuals for malaria and Ebola but also does CBCs, BMPs, CRP, and oral/nasal swabs to check for respiratory infections. (CBC-complete blood count-essentially tells us if you are battling an infection or if you are anemic; BMP-basic metabolic panel-tells us what your electrolytes levels in your blood are which can help us tell if you are dehydrated; C-reactive protein-blood test that shows if inflammation is present). So, at ten pm Tuesday night, I was loaded up in the back of an ambulance and was on my way to Kerrytown; no longer the healthcare worker, now, the patient.

We arrived that evening and, even having a good idea what to expect after working in an ETC for five weeks I was nervous. Thoughts swirling around my head: "Why had I remained awake 26 hours straight over the weekend? That was dumb." "I am supposed to leave in 6 days!! Why did I have to get sick now?!" "Will I be able to go back to work or am I done?" "Think, self, think, did you have any issues with your PPE recently? Touch anyone while in the market that may have been sick? Did you wash your hands before touching your eyes?!" "What is my family thinking right now? I wish I could call them. I don't think I have Ebola...but I don't know why my temperature is higher than it's been..."

I had the local nokia phone with me but had left my US phone in the capable hands of one of my coworkers and requested that she keep my family and a few others informed of information as I knew how things were going. She graciously agreed, and was the recipient of a running commentary of my time in Kerrytown. I am so thankful for her--she kept me from freaking out the first day I was in there-kept texting me lyrics to various hymns. My other co-workers were also beyond wonderful--sending encouraging texts, sending me credit to the phone so that I did not run out and could continue contacting the outside world, and calling me to help me pass the time and to tell me about work--what I was missing, did certain patients get to go home, the national staff has been asking where I am...

We arrived at Kerrytown around midnight. My blood was tested for malaria at bedside-think fingerprick method. My bed was more comfortable than the one I had been sleeping on the entire time in SL! I was given a mosquito net, some water, some snacks, and disposable scrubs for pajamas. There was a camera in the tent that was on the entire time I was in there. I was told to "wave at the camera if you need anything." Umm...that's helpful, it is...but where can I change clothes?! I settled down for the night and tried to sleep--the waiting had begun.

Breakfast was porridge and a small sandwich with some kind of spread on the inside; both food items remarkably resembled what we serve at our ETC. Around 9 they drew my blood and did some swabs then left me alone. Now the wait for results had begun. I didn't take much to Kerrytown--anything that enters high risk is burned or chlorinated. I had taken the nokia, a small book of index cards, a pen, a printed out copy of Hebrews 11 (although only the first page...no idea where the second half of the chapter is!), the clothes I was wearing, socks in case my feet got cold, a few spare underclothes, and my malaria medicine since Wednesday was close.

I continued working on memorizing Hebrews 11 then played a few sudoku games on the phone. There are one hundred games...but the phone doesn't save your progress unless you immediately start the next puzzle after beating one...which I learned the hard way on puzzles 1 & 2..."Wait a second...this feels familiar...hmm, yep! I have solved this puzzle before!" And it won't let you skip puzzles. I wrote down a few of them that way if my progress was lost again, at least I wouldn't have to re-solve the puzzle from the beginning.

A doctor came in to assess me and asked me many questions regarding my symptom history and about how I was feeling presently. I begin to be quite curious--why is he asking these questions, what is he looking for, and what do I not yet know that he does? He then told me--all your blood work and your swabs are back except the Ebola pcr--all lab work is normal. I don't know what you have. Shortly thereafter he left the tent and I was again alone with my thoughts.

Ebola is a terribly isolating disease. Once you get sick, others avoid you. They have to--else they will also become sick. When you are a suspect Ebola case, you are also isolated. You are treated as infectious and rightly so--you could have Ebola, we haven't ruled it out yet. Being on the other side of that isolation---sucks. You can't get away from the thoughts plaguing your mind. I at least could pray and sing and knew that Jehovah Shammah was near; I knew that Jehovah Rapha could heal me of whatever was going on. There are mountains all around Kerrytown; I began to sing the song based on Psalm 121:
"I lift my eyes up, to the mountains/where does my help come from? My help comes from you! Maker of Heaven, Creator of the Earth/Oh how I need you Lord, you are my only hope/You are my only prayer/And so I'll wait for you to come and rescue me/Come and give me life..."

Sometime after 3 pm, the doctor who had visited me that morning called my name and I left the tent. He was on the other side of the fence and said, "You're negative! Results are back! Praise God from whom all blessings flow! I began a flurry of calls/texts to update my co-workers and family. I then thought I would be released...but as my labwork had not provided a diagnosis, I needed to stay in Kerrytown until I was 72 hours past my first fever. 72 hours was 3 pm Thursday...which means my second result would not be back until late Thursday evening or perhaps night.

Now...to wait. Again.

Thankfully Kerrytown has a lab on site. Some of our patients have to wait 12-24 hours for a result, and sometimes that result is the ever-frustrating "indeterminate" which means it will be re-run but may need to re-collected. The time I had to spend waiting was quite torturous---I cannot imagine how discouraging it must be to receive an "indeterminate" result. Some of our patients believe we are collecting their blood to sell it or to find better ways to poison them--they are quite suspicious. Makes it far harder to develop trust when we have to re-draw their blood because we couldn't read the result of the first blood drawn :-(

This is a long enough post...I will write more about my adventures in Kerrytown soon.

Three Returned Home!

The 5-yr-old went home!! I wish I had worked Friday during the day--we discharged THREE from confirmed which may be our record of discharging 'cured' at one time. We sent the pregnant lady to the MSF facility-they have ultrasound equipment there. We also were able to discharge one of the ten-yr-olds! What a day of celebration!

However, Ebola seems to never allow us to celebrate for long. Just a few hours later the results came back for the patients from the quarantined house-positive, all three. We again have 4 in confirmed. The fourth one has been there for almost two weeks...we drew her blood Saturday and got a negative result back, her first!

Hard to believe I have only a week left in this country. I have had the opportunity to have several discussions about Isa with Muslims this past week. Pray that I will have more opportunities and that God will give me the words to say.